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Implementing academic detailing for breast cancer screening in underserved communities
Sherri Sheinfeld Gorin1, Alfred R Ashford, Rafael Lantigua
1Department of Health and Behavior Studies, Columbia University, 525 W 120th Street, New York, NY, USA. ssg19@columbia.edu
Implementation Science : IS
|December 19, 2007
Summary
Enhanced academic detailing improved breast cancer screening recommendations by primary care physicians in underserved urban areas. This intervention showed a positive impact on Clinical Breast Examination (CBE) and increased mammography and breast self-examination (BSE) reporting.
Area of Science:
- Public Health
- Preventive Medicine
- Health Disparities
Background:
- African American and Hispanic women in underserved urban areas face higher breast cancer mortality rates.
- Primary care physicians (PCPs) are crucial for recommending breast cancer screening.
- Academic detailing is a strategy to improve PCP screening recommendations, but its effectiveness in underserved areas is understudied.
Purpose of the Study:
- To assess the effectiveness of an enhanced, multi-component academic detailing intervention.
- To increase breast cancer screening recommendations among community-based urban physicians in medically underserved areas.
Main Methods:
- Two medically underserved communities were matched and randomized into intervention and control groups.
- Ninety-four physicians in northern Manhattan (intervention) and 74 in the South Bronx (control) participated.
- Intervention involved enhanced academic detailing based on American Cancer Society guidelines; control group received no intervention. Physician self-reported mammography, Clinical Breast Examination (CBE), and breast self-examination (BSE) teaching were measured.
Main Results:
- A statistically significant intervention effect was found for the recommendation of CBE for women aged 40 and over.
- Mammography and breast self-examination (BSE) reporting increased in both groups from baseline to follow-up.
- Factors associated with increased screening included additional educational programs, enhanced self-efficacy, chart reminders, computer-based tracking, patient education materials, performance targets, and staff involvement.
Conclusions:
- Enhanced academic detailing demonstrated some improvement in breast cancer screening practices.
- The intervention shows promise for primary care physicians in urban underserved communities.
- Further research may explore optimizing multi-component strategies for breast cancer prevention in vulnerable populations.
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